Web-Based Intervention for Family Carers of Persons with Dementia and Multiple Chronic Conditions (My Tools 4 Care): Pragmatic Randomized Controlled Trial
Web-Based Intervention for Family Carers of Persons with Dementia and Multiple Chronic Conditions (My Tools 4 Care): Pragmatic Randomized Controlled Trial
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DOI：
10.2196/10484
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发表时间：
2018-06-01
影响因子：
7.4
通讯作者：
Ruiz, Kathya Jovel
中科院分区：
文献类型：
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作者：
Duggleby, Wendy;Ploeg, Jenny;Ruiz, Kathya Jovel
背景：My Tools 4 Care （MT4C）是一种基于网络的干预，是基于过渡理论开发的。这是一个交互式的、自我管理的便携式工具包，包含六个主要部分，旨在通过过渡经验支持社区生活的阿尔茨海默病和相关痴呆症及多种慢性疾病患者的护理人员。目的：本研究的目的是评估MT4C在提高社区生活的老年阿尔茨海默病及相关痴呆和多种慢性疾病患者的护理人员的希望、自我效能和健康相关生活质量方面的有效性。方法：于2015年6月至2017年4月进行多地点、实用、混合方法、纵向、重复测量、随机对照试验。符合条件的参与者被随机分为治疗组（MT4C）或教育对照组。根据基线测量，治疗组的护理人员接受了3个月的密码保护访问MT4C。训练有素的研究助理通过电话收集参与者在基线、1、3和6个月的希望（赫斯希望指数[HHI]）、自我效能（一般自我效能量表）和与健康相关的生活质量（短表12项[版本2]健康调查；SF-12v2）数据。在基线、3个月和6个月时测量参与者的卫生和社会服务的使用和成本（卫生和社会服务利用清单）。使用协方差分析来确定3个月时的组间差异，使用广义估计方程来确定组间随时间的差异。结果：共199名护理人员参与本研究，其中治疗组101名，教育对照组98名。其中，23%（45/199）的参与者在研究期间因各种原因退出，包括痴呆症患者住院或死亡以及缺乏护理时间。在治疗组中，73%（74/101）的护理人员在3个月内至少使用一次MT4C。主要结局指标（SF-12v2心理成分综合评分）在3个月时各组或时间无显著差异；然而，hhi因子2的差异有统计学意义(P=。01)，治疗组的希望评分高于对照组。一般估计方程显示，在所有时间点的心理成分总结得分方面，组间差异无统计学意义。磨耗和并非治疗组的所有护理人员都使用MT4C这一事实可能解释了主要结果变量缺乏统计学显著结果的原因。结论：尽管在主要结果变量（心理成分得分）方面各组之间没有显著差异，但在希望因素之一方面的显著差异表明MT4C对参与者的生活有积极影响。
Background: My Tools 4 Care (MT4C) is a Web-based intervention that was developed based on the transitions theory. It is an interactive, self-administered, and portable toolkit containing six main sections intended to support carers of community-living persons with Alzheimer's disease and related dementia and multiple chronic conditions through their transition experiences.Objective: The objective of our study was to evaluate the effectiveness of MT4C with respect to increasing hope, self-efficacy, and health-related quality of life in carers of community-living older persons with Alzheimer's disease and related dementia and multiple chronic conditions.Methods: A multisite, pragmatic, mixed methods, longitudinal, repeated-measures, randomized controlled trial was conducted between June 2015 and April 2017. Eligible participants were randomized into either treatment (MT4C) or educational control groups. Following baseline measures, carers in the treatment group received 3 months of password-protected access to MT4C. Trained research assistants collected data from participants via phone on hope (Herth Hope Index [HHI]), self-efficacy (General Self-Efficacy Scale), and health-related quality of life (Short Form-12 item [version 2] health survey; SF-12v2) at baseline, 1, 3, and 6 months. The use and cost of health and social services (Health and Social Services Utilization Inventory) among participants were measured at baseline, 3, and 6 months. Analysis of covariance was used to identify group differences at 3 months, and generalized estimating equations were used to identify group differences over time.Results: A total of 199 carers participated in this study, with 101 participants in the treatment group and 98 in the educational control group. Of all, 23% (45/199) participants withdrew during the study for various reasons, including institutionalization or death of the person with dementia and lack of time from the carer. In the treatment group, 73% (74/101) carers used MT4C at least once over the 3-month period. No significant differences in the primary outcome measure (mental component summary score from the SF-12v2) by group or time were noted at 3 months; however, significant differences were evident for HHI-factor 2 (P=. 01), with higher hope scores in the treatment group than in the control group. General estimating equations showed no statistically significant group differences in terms of mental component summary score at all time points. Attrition and the fact that not all carers in the treatment group used MT4C may explain the absence of statistically significant results for the main outcome variable.Conclusions: Despite no significant differences between groups in terms of the primary outcome variable (mental component score), the significant differences in terms of one of the hope factors suggest that MT4C had a positive influence on the lives of participants.